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Vol. 35. Issue 4.
Pages 167-172 (April 1999)
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Vol. 35. Issue 4.
Pages 167-172 (April 1999)
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Estudio descriptivo de los pacientes diagnosticados de asma en una consulta neumológica de ámbito comarcal
Descriptive study of patients diagnosed of asthma in a regional respiratory medicine practice
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4554
M. Perpiñàa
a Servicio de Neumología. Hospital La Fe. Valencia
C. Pellicer*, P. Lorente, P. Valero, M.J. Cremades, J. Fullana, M.J. Gilabert, I. García Peiró
Unidad de Neumología. Hospital Francesc de Borja. Gandía
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Objetivo

Describir las características de los pacientes diagnosticados de asma bronquial en una consulta neumológica comarcal.

Metodología

Durante 2 años, 88 pacientes adultos completaron un protocolo prospectivo-diagnóstico de asma bronquial que incluía: historia clínica con determinación de la probabilidad diagnóstica inicial de asma, valoración de atopia y estudio funcional respiratorio que incluyó espirometría con test broncodilatador, registro de la variabilidad del flujo espiratorio máximo y prueba de provocación bronquial con metacolina. Se diagnosticó asma bronquial ante síntomas con alta o media probabilidad diagnóstica inicial de asma y test de reversibilidad y/o hiperrespuesta bronquial positivo. Se valoró la severidad de la enfermedad utilizando los criterios del consenso Global Iniciative for asthma. Para la comparación de datos se utilizó el test de la t de Student y la χ2.

Resultados

Se diagnosticó asma bronquial en 24 varones (30%) y 56 mujeres (70%), edad media 43,0 ± 17,6 años límites 16-68 y entre los que sólo se detectaron diferencias significativas en los parámetros funcionales y en el consumo de cigarrillos (p<0,05). Procedían de atención primaria 53 casos (66%), 22 (27%) del hospital y cinco de otro lugar. El primer grupo presentaba respecto del segundo menor tiempo de evolución de la enfermedad (p=0,05). Se clasificaron como asma leve 61 pacientes (76%), los cuales tenían menor edad y tiempo de evolución que los de mayor severidad (16 con asma moderada y tres severa) (p<0,05). Los síntomas orientaban el diagnóstico con una probabilidad diagnóstica inicial elevada en 57 casos (71%), que se incrementó al 89,5% en el asma de mayor severidad, detectándose diferencias significativas (p<0,05) respecto del asma leve. En 39 pacientes se diagnosticó asma intrínseca y extrínseca en 41 casos, constatándose entre ambos grupos diferencias significativas en la edad y el valor de IgE total (p<0,01).

Conclusiones

Se diagnostica asma bronquial en mujeres, en proporción más de dos veces superior a la de varones. Dos tercios de los pacientes proceden de atención primaria. Existe un claro predominio de casos de asma bronquial leve. Los síntomas clínicos orientan el diagnóstico con probabilidad diagnóstica inicial alta en la mayor parte de los casos.

Palabras clave:
Clasificación del asma bronquial
Asma bronquial en atención primaria
Asma bronquial leve
Objective

To describe the characteristics of patients diagnosed of bronchial asthma (BA) in a regional respiratory medicine practice.

Methods

Over a period of two years, 88 adult patients followed a prospective-diagnostic protocol for BA that included taking of patient history to determine the probability of initial diagnosis (PID) of asthma, assessment of atopy and a lung function test that included spirometry with a bronchodilator test, recording of forced expiratory volume, and a methacholine challenge test. BA was diagnosed when symptoms denoting high or moderate PID were present and there was a positive reversibility and/or bronchial hyperreactivity test. The severity of disease was evaluated using the consensus criteria of the Global Initiative for Asthma (GINA). A student-t test and a χ2 test were performed to compare data.

Results

BA was diagnosed in 24 men (30%) and 56 women (70%) with a mean age of 43.0 ± 17.6 years (range 16 to 68). Significant differences between men and women were detected only for function parameters and cigarette consumption (p<0.05). Fifty-three patients (66%) were refe- rred by general practitioners, 22 (27%) were referred by hospital, and 5 came from other sources. The first group had a shorter history of disease course (p=0.05) upon first evaluation. Sixty-one patients (76%) had mild asthma; these patients were younger and had had symptoms for a shorter period of time than those with more serious degrees of disease (16 with moderate asthma and 3 with severe asthma) (p<0.05). Symptoms indicated a high PID in 57 cases (71%), and this figure increased significantly to 89.5% for those with more severe asthma (p<0.05). Asthma was intrinsic for 39 patients and extrinsic for 41, with significant differences in age and total IgE between the two groups (p<0.01).

Conclusions

1. BA is more than twice as common among women as among men. 2. Two thirds of patients are referred by general practitioners. 3. Mild asthma clearly predominates. 4. Clinical symptoms point to asthma, the PID in most cases being high.

Key words:
Classification of bronchial asthma
Bronchial asthma in general practice
Mild bronchial asthma
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Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
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